Preventing serious complications from COVID-19 in potentially vulnerable populations in high risk environments, such as prisons, and preventing spread to surrounding communities needs a coordinated evidence-based approach to managing outbreaks of COVID-19 in prison settings.

Researchers at the University of Oxford, Department of Psychiatry, conducted a systematic review on managing outbreaks of highly contagious diseases in prisons, using 28 studies of investigations, which were all based in high-income countries with documented outbreaks of tuberculosis, influenza (types A and B), varicella, measles, mumps, adenovirus and COVID-19.

A number of challenges specific to managing infectious disease outbreaks in prisons were identified. Contact tracing in prisons is complicated by reluctance to disclose symptoms due to stigma, concerns about confidentiality, and fear of further restrictions, such as prolonged periods of medical isolation. Effective isolation and quarantine measures are difficult due to overcrowding, poor ventilation, sanitation and hygiene, which are common in many prisons. Prisons can easily become a reservoir for COVID-19 infection to the community as turnover is high and transmission can occur at multiple points including via staff.

In addition, people in prison have higher rates of many physical and mental health comorbidities, consistently shown to be more common than in community persons of similar age. Thus, the paper recommends a coordinated approach to managing outbreaks in these settings with prisons and public health authorities working closely.

Professor Seena Fazel, Department of Psychiatry, University of Oxford, said, ‘Prisons are high-risk settings for the transmission of contagious diseases and there are considerable challenges in managing outbreaks in them. Our research suggests that people in prison should be among the first groups to receive any COVID-19 vaccine to protect against infection and to prevent further spread of the disease. The prison population is generally at higher risk of complications from infection because of the increased prevalence of underlying health conditions, and the overrepresentation of marginalised groups that have been disproportionately affected by COVID-19. A public health approach to managing COVID-19 in prisons is important now and for any future infectious disease outbreaks.’

The research highlights some important actions which health authorities and prisons should do including:

  • Sharing clear and up-to-date information about health risks, prevention and control measures with people in prisons and correctional staff
  • Assessing the benefits of prolonged infection control strategies against the potential negative consequence of such measures on the mental health of the prison population
  • Ensuring that people in prison are released to safe and suitable housing, to ensure that transmission risks are reduced.

According to the New York Times (16 November 2020), more than 252,000 people in prisons and jails have tested positive for COVID-19, and at least 1,450 have died from complications. In the UK (31 October 2020), the Ministry of Justice reports 55 COVID-related deaths of people in prison. Since the start of the pandemic, there have been 1,529 positive cases in the prison population in England and Wales across 99 establishments.

The research involved a collaboration between infectious diseases and mental health researchers in the US, UK and China, and was partly funded by the Wellcome Trust.